Effectiveness and safety of isoniazid chemoprophylaxis for HIV-1 infected patients from Rio de Janeiro.

The clinical and epidemiological characteristics, adverse events, treatment adherence and effectiveness of isoniazid chemoprophylaxis were analyzed in a cohort of 138 tuberculosis/HIV-coinfected patients. An open, non-randomized, pragmatic prophylactic trial was conducted on adult patients with a normal chest X-ray and positive tuberculin skin test (>or= 5 mm) who received isoniazid chemoprophylaxis (300 mg/day) for six months. The mean of follow up was 2.8 years (SD 1.3). Adherence to chemoprophylaxis was 87.7% (121/138). Only one patient presented tuberculosis after the end of chemoprophylaxis, corresponding to 0.3 cases per 100 persons per year. The relative risk of some adverse effects was 4.6 times higher (95% CI: 1.9-11.5) in patients with positive anti-HCV serology (4/9, 44.4%) compared to those with negative serology (12/129, 9.6%) (p = 0.002). This study provides evidence regarding the effectiveness and safety of a short and self-administered isoniazid regimen. We recommend the implementation of this routine by health service practitioners.

Standardization of intralesional meglumine antimoniate treatment for cutaneous leishmaniasis.

INTRODUCTION:: Intralesional treatment for cutaneous leishmaniasis has been applied for over 30 years at the Oswaldo Cruz Foundation, Rio de Janeiro, with good therapeutic results and without relevant systemic toxicity. METHODS: Meglumine antimoniate was injected subcutaneously, using a long medium-caliber needle (for example, 30mm × 0.8mm); patients received 1-3 injections, with 15-day intervals. RESULTS: The technique is described in detail sufficient to enable replication. CONCLUSIONS:: The treatment of cutaneous leishmaniasis with intralesional meglumine antimoniate is a simple, effective, and safe technique, which may be used in basic healthcare settings.

Estigmatização social pela leishmaniose cutânea no estado do Rio de Janeiro, Brasil / Social stigmatization of cutaneous leishmaniasis in the state of Rio de Janeiro, Brazil / Estigmatización social de la leishmaniasis cutánea en el estado del Río de Janeiro, Brasil

Embora a leishmaniose cutânea raramente evolua para óbito, produz um impacto negativo na vida cotidiana, com consequências psicológicas e sociais que afetam as relações pessoais e a qualidade de vida do indivíduo afetado. O objetivo deste estudo foi demonstrar efeitos de comportamentos estigmatizantes, suas consequências psicossociais e sua possível relação com as ideias de cura, contágio e causalidade, a partir do relato verbal dos indivíduos com lesões cutâneas ativas de leishmaniose. Foram entrevistados 24 pacientes com lesões em áreas expostas da pele: quinze do gênero masculino e nove do feminino. Os depoimentos e questões abordadas no estudo mostram um importante impacto psicológico e social, especialmente no gênero feminino, com manifestações de exclusão social e atitudes estigmatizantes. As ideias preconcebidas popularmente sobre a causalidade e o contágio da doença parecem ser responsáveis por essas consequências. Portanto, fazem-se necessários estudos que incorporem uma abordagem multidisciplinar e contextualizada à história sociocultural das populações para minimizar o impacto negativo na vida dos indivíduos afetados. (AU)

Although cutaneous leishmaniasis rarely evolves to death, it has a negative impact on daily life, with psychological and social consequences that interfere with the personal relationships and with the quality of life of the affectedindividual. The objective of this study was to analyze the verbal report of individuals with active cutaneous leishmaniasislesions in order to identify the psychosocial consequences and to demonstrate effects of stigmatizing behaviors and their possible relation with the ideas of cure, contagion and causality. We interviewed 24 patients with active lesions on exposed areas of the skin: fifteen of the male and nine of the female gender. The statements and issues addressed in the study show an important psychological and social impact, especially regarding the female gender, with manifestations of social exclusion and stigmatizing attitudes. Popularly preconceived ideasabout causality and disease contagion seem to be responsible for these consequences. Therefore, there is a needfor studies that incorporate a multidisciplinary and contextualized approach to the sociocultural history of populationsin order to minimize the negative impact on the lives of the affected individuals.

Aunque la leishmaniasis cutánea raramente evoluciona hacia la muerte, produce un impacto negativo en la vidacotidiana, con consecuencias psicológicas y sociales que afectan a las relaciones personales y la calidad de vida del individuo afectado. El objetivo fundamental de este estudio, fue demostrar los efectos de los comportamientos estigmatizantes, sus consecuencias psicosociales y su posible relación con las ideas de cura, contagio y causalidad, a partir de los relatos de los individuos con lesiones cutáneas activas de leishmaniasis. Fueron entrevistados 24pacientes con lesiones en áreas expuestas de la piel: quince hombres y nueve mujeres. Las declaraciones y temas abordados en el estudio muestran un importante impacto psicológico y social, especialmente en el género femenino, con manifestaciones de exclusión social y actitudes de estigmatización. Las ideas preconcebidas popularmentesobre la causalidad y el contagio de la enfermedad parecen ser responsable de esas consecuencias. Por lo tanto, sonnecesarios estudios que incorporen un enfoque multidisciplinario y contextualizado a la historia socio-cultural de las poblaciones, para minimizar el impacto negativo en la vida de las personas afectadas.

Standardization of intralesional meglumine antimoniate treatment for cutaneous leishmaniasis

Abstract INTRODUCTION: Intralesional treatment for cutaneous leishmaniasis has been applied for over 30 years at the Oswaldo Cruz Foundation, Rio de Janeiro, with good therapeutic results and without relevant systemic toxicity. METHODS Meglumine antimoniate was injected subcutaneously, using a long medium-caliber needle (for example, 30mm × 0.8mm); patients received 1-3 injections, with 15-day intervals. RESULTS The technique is described in detail sufficient to enable replication. CONCLUSIONS: The treatment of cutaneous leishmaniasis with intralesional meglumine antimoniate is a simple, effective, and safe technique, which may be used in basic healthcare settings.

Percepção do risco de transmissão de zoonoses em um Centro de Referência / Perception risk of transmission of zoonoses in a Reference Center / Percepción del riesgo de transmisión de zoonosis en un Centro de Referencia

Questões relacionadas às condições sociais, econômicas, culturais e ambientais têm contribuído para a expansão da leishmaniose e esporotricose. Pretendeu-se identificar a percepção de risco de transmissão dessas doenças e os fatores que influenciam no processo de adoecimento. Foram entrevistados 27 pacientes(sete com leishmaniose e vinte com esporotricose). A maioria não identificou algum tipo de risco específico de transmissão e nomeou como fator principal a contaminação ambiental Ações de promoção de saúde devem estar integradas com outras abordagens que levem em conta a participação dos indivíduos, particularidades sociais, culturais, geográficas e políticas...

Issues related to social, economic, cultural and environmental conditions have contributed to the expansionof leishmaniasis and sporotrichosis. We attempted to identify the perception of risk of transmissionof these diseases and the factors that influence the disease process. Twenty-seven patients (seven withleishmaniasis and 20 with sporotrichosis) were interviewed. The majority has not identified any specifictype of risk of transmission and attributed as the main factor to environmental contamination. Actions ofhealth promotion should be integrated with other approaches that take into account the participation ofindividuals, social, cultural, geographical and political features...

Preguntas relacionadas a las condiciones sociales, económicas, culturales y ambientales han contribuidoa la propagación de la leishmaniasis y la Esporotricosis. Su objetivo es identificar la percepción deriesgo de transmisión de estas enfermedades y los factores que influyen en el proceso de la enfermedad.Entrevistamos a 27 pacientes (siete con la leishmaniasis y 20 con esporotricosis). La mayoría no identificaningún tipo específico de riesgo para la transmisión y atribuye como el principal factor a la contaminaciónambiental. Acciones de promoción de la salud deben ser integradas con otros enfoques que tomen en cuentala participación de los individuos, las particularidades sociales, culturales, geográficas y políticas...

Social epidemiology, education, and health promotion in infectious disease

This short communication discusses a project in Rio de Janeiro involving an attempt at imparting clinical and social epidemiology knowledge through educational initiatives. In small groups, social epidemiology was discussed in the context of a clinical/epidemiological project on various infectious diseases. Relevant knowledge was produced collaboratively by a multidisciplinary team of clinical research and project participants, comprising patients, relatives, friends, and health workers. An improvement in the learning capacity of participants was observed, fostering active appropriation of scientific knowledge. In dealing with infectious disease, social epidemiology contributes to the development of new strategies for collaborative research and disease prevention.

Esta comunicação discute um projeto desenvolvido no Rio de Janeiro, Brasil, que vincula epidemiologia clínica e epidemiologia social por meio de iniciativas educacionais. Abordagens da epidemiologia social foram utilizadas num projeto clínico-epidemiológico em doenças infecciosas, no qual a construção do conhecimento envolveu os próprios participantes (pacientes, familiares, amigos e trabalhadores da saúde) juntamente com a equipe multidisciplinar de pesquisas clínicas. Foi observada uma melhoria na capacidade de aprendizagem dos participantes que contribuiu para a apropriação ativa do conhecimento científico. Ao lidar com doenças infecciosas, a epidemiologia social favorece o desenvolvimento de novas estratégias de investigação colaborativa e de prevenção da doença.

Effectiveness and safety of isoniazid chemoprophylaxis for HIV-1 infected patients from Rio de Janeiro

The clinical and epidemiological characteristics, adverse events, treatment adherence and effectiveness of isoniazid chemoprophylaxis were analyzed in a cohort of 138 tuberculosis/HIV-coinfected patients. An open, non-randomized, pragmatic prophylactic trial was conducted on adult patients with a normal chest X-ray and positive tuberculin skin test (> 5 mm) who received isoniazid chemoprophylaxis (300 mg/day) for six months. The mean of follow up was 2.8 years (SD 1.3). Adherence to chemoprophylaxis was 87.7 percent (121/138). Only one patient presented tuberculosis after the end of chemoprophylaxis, corresponding to 0.3 cases per 100 persons per year. The relative risk of some adverse effects was 4.6 times higher (95 percent CI: 1.9-11.5) in patients with positive anti-HCV serology (4/9, 44.4 percent) compared to those with negative serology (12/129, 9.6 percent) (p = 0.002). This study provides evidence regarding the effectiveness and safety of a short and self-administered isoniazid regimen. We recommend the implementation of this routine by health service practitioners.